Explanation

Motor rrhage (eg, abdominal distension; vital signs, hematocrit,

Abdominal hemoglobin), paralytic ileus (eg; bowel sounds); neurovascular deficits (eg, extremity
circulation, sensation, abdominal and pelvic organs (eg, small bowel, sigmoid colon; bladder, urethra,
uterus, o the trauma and/or a retroperitoneal hematoma: these should be reported to the health care
provider (HCP) (Option 1).

(Options 2 and 4) the bleeding. During the acute hemorrhage. hemoglobin and hematocrit can bs and
can manifest as should assess for internal movement); and abdominal and genitourinary organ injuries
(eg, hematuria, urine output abdominal distension and paralytic ileus.

. This is a second priority over Tenderness, organ damage and internal hemorrhage.

(Option 3) Hemoglobin of 11.5 g/dL (115 g/L) and hema

Educational objective: The pelvis contains vascular structures and pelvic tocrit of 34% (0.34) are slightly
lower e normal and will take some bruising, and ecchymosis over the injured bones are expected and do
not need to be reported to the HCP. However; it would be important to communicate ecchymosis over
the suprapubic area to the HCP as this could indicate time to reduce to significant levels fracturethan
normal and may be from

actual bleeding findings. organs fractures. The pelvis contains due to serious intra-abdominal
prostatevehicle collisions and motorcycle crashes, followed by falls, are the most common mechfor es)
and hemo).. Absent bowel sounds can indicate the presence of a paralytic ileus related tbleeding or
injury to the. Significant internal hemorrhage is common with pelvic

anisms Therefore, when caring for a client with a fractured pelvis, in addition to several large vascular
structures (eg, internal and extiliac veins and arteri5 mL/kg/hr). distension could be pain, the nurse <0.
pelvic bowel or urinary structures pass meconium with nd diet modifications, including exercise, stress
reduction, and reduced in the expected 24

umbilical cord that should have disintegrated at 8 weeks in utero but became an out pouch in the small
intestin ernal

Explanation abdomen and will not -48 hours. They will also have difficulty feeding and often vomit green
bile. period to retained blood due to a partial blockage Bright red bleeding from the rectum would not
occur. However, rectal bleeding could be a symptom of Meckel's in the tube. Bright red drainage
indicates drainage lifestyle a

disease will not have passed meconium. diverticulum, a remnant of the e.

(Option 4) Nonbilious vomiting is seen intake of gas-producing foods and

(Option 1) An infant with Hirschsprung in conditions where the pathology is proximal to the pylorus (eg,
hypertrophic pyloric stenosis). Bilious (green) vomiting is seen in conditions where the pathology is distal
to the duodenum as the common bile duct drains at the duodenum. In Hirschsprung disease, the
pathology is at the distal colon; green bilious vomiting is expected.

Educational objecbowel syndrtive: Hirschsprung disease is caused by a lack of specialized nerve cells in
portions of will not pass meconium but will

order characterized by abdominal pain and altered bowel prung disease, diarrhea. or lude:

• Keep a daily record of symptoms. dietary intake; and stress level a combination of both). Clients with
IBS also commonly lifesmotility (constipationhave distended abdomens and bilious emesis

Irritable ome (IBS) is a chronic gastrointestinal dis the distal large intestine; this renders the internal
sphincter unable to relax. Infants with Hirschstyle fications. anagement strategies inc

to help

experience bloating, nausea; urgency, and flatulence. Symptoms of IBS are often managed through

stress. Reduce daily caffeine intake, as caffeine can affect bowel motility iet modioducing
foodAppropriate ms: legumes (eg, beans), cruciferous vegetables (eg, cabbage, broccoli), and foods
containing identify IBS triggers (Option 2).

• Limit intake of gas-prand d S symptoms. Physical exercise improves bloating; constipation, and may
help further reduce fructose (eg, honey otherwise drastically reduce their oral intake (eg, clear liquid
diet); even during periods of moderate or severe symptoms, apples) (Option 3).

• Practice s ption tress reduction stress

interventiotipatin may be requand trigger symptoms (Option 5).

(O1) To prevent malnutired.

bowel motility (conson, diarrhea, or a combination of both). IBS is managed primarily through caffeine.
are associated withtechniques (eg, meditation, yoga) and perform regular exercise (Option 4). Anxiety
and

increased IB

rition, clients with IBS should not fast or. Clients experiencing increased symptoms should talk with the
health care provider, as pharmacologic

owing a thoracoionaltomy, chest tube by serous (yellow

Educat objective: Irritable bowel syndrome (IBS) is a chronic disorder characterized by abdominal pain
and altered Explanation) over a
(50-500 mL for the first 24 hours) is expected to be sangus (bright red) for several hours and then
change to ays. A rush of dark bloody drainage from the chest tube

(Option 2) Theit is when the client wasImmediately foll turned followperiod of minimal drainage is most
likely related immediately of t tube should not be clamped g a and would be of immediate concern.
because ed signs and cardiovascular bright red drainage or continued increased drainage (>100
mL/hrardia, tachypnea, decreas cheserosanguineous (pink) followed active bleeding in placed to drain
the fluid leaking after surgery. of a few duineos status that usually have

(Option 3 a chest tube in place for capillary refill, cool and pale skin). This) The nurse would notify the
health care p) and of changes in the client's vital several days following a thoracotomy to drain blood
from could indicate bleeding (eg, hypotension, tachycrovider

postoperative levels are stable at this time This is not the appropriate action.

Educ bject ational oive: rush of dark bloody ge is t the appropriate action.

(Option 4) It suspected, but the to request repeat serum hematocrit and hemoglobin levels if active
bleeding

this renders the internal anal sphincter unable to relax. As a result, there is no peristalsis and stool is not
passed of the distal large intestine missing nerve cells;. Newborns Hirschsprung dise exhi

is concern. child is born with sombe appe sections

A client chest drainage indicates active bleeding and would be of repositioned following a period of will
is no. Adrainage from the tube when the client coug, turns, or is in the tube. Brigh the pleural space
most likely related d blood due to hs a partial blockage immediate would ropriate t red minimal draina

OUWorld ase occurs when a bit symptto retaineoms of distal intestinal obstruction. They have a
distended